Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy
Authors: Matteo Rottoli, Alice Gori, Gianluca Pellino, Maria Elena Flacco, Cecilia Martellucci, Antonino Spinelli, Gilberto Poggioli, Angela Romano, Angela Belvedere, Antonio Lanci Lanci, Daniele Parlanti, Gabriele Vago, Paola Pezzuto, Anna Canavese, Gerti Dajti, Stefano Cardelli, Caterina Catalioto, Iris S Russo, Tommaso Violante, Daniele Morezzi, Ludovica Maurino, Eleonora Filippone, Dajana Cuicchi, Paolo Bernante, Elio Jovine, Raffaele Lombardi, Michele Masetti, Chiara Cipressi, Maria F Offi, Cristina Larotonda, Silvana B Puglisi, Augusto Barbosa, Roberto Vaiana, Paolo M Bianchi, Carlo Tonti, Claudio Codignola, Luigi Zorcolo, Angelo Restivo, Simona Deidda, Marcello E Marchetti, Luca Ippolito, Gaya Spolverato, Salvatore Pucciarelli, Francesco Marchegiani, Giacomo Ghio, Gaya Zagolin, Dajana Glavas, Monica Tomassi, Riccardo Rosati, Ugo Elmore, Lorenzo Gozzini, Riccardo Calef, Francesco Puccetti, Andrea Cossu, Andrea Vignali, Mario Morino, Marco E Allaix, Gaspare Cannata, Erica Lombardi, Carlo A Ammirati, Chiara Piceni, Piero Buccianti, Riccardo Balestri, Marco Puccini, Daniele Pezzati, Roberto d'Ischia, Vito F Asta, Benedetta Sargenti, Giacomo Taddei, Federica Bonari, Giulia Boni, Alessandro Ferrero, Michela Mineccia, Federica Gonella, Marco Palisi, Francesco Danese, Valeria Cherubini, Serena Perotti, Michele Carvello, Fabio Carbone, Antonio Luberto, Eleonora Calafiore, Francesca De Lucia, Matteo Sacchi, Diego Sasia, Maria C Giuffrida, Edoardo Ballauri, Mathieu Cardile, Serena Armentano, Elsa Beltrami, Gabriele Preve, Barbara Vercellone, Marta Mozzon, Cristina Folliero, Chiara Lirusso, Massimo Vecchiato, Antonio Ziccarelli, Davide Gattesco, Luisa Moretti, Sara Crestale, Filippo Banchini, Patrizio Capelli, Andrea Romboli, Gerardo Palmieri, Luigi Conti, Nicholas Rizzi, Deborah Bonfili, Nicolò de Manzini, Paola Germani, Edoardo Osenda, Sara Cortinovis, Carlotta Giunta, Stefano Fracon, Hussein Abdallah, Selene Bogoni, Nazario Portolani, Riccardo Nascimbeni, Sarah Molfino, Guido A M Tiberio, Ilenia Garosio, Giulia Lamperti, Diego Rigosa, Giorgio Ercolani, Leonardo Solaini, Davide Cavaliere, Andrea Avanzolini, Fabrizio D'Acapito, Leonardo L Chiarella, Daniela Di Pietrantonio, Domenico Annunziata, Roberta Piccolo, Mario Sorrentino, Mauro Pansini, Alessandro Cojutti, Michele Graziano, Francesco Callegari, Laura Balzarotti, Vitale R Dameno, Antonio Cattaneo, Giuliano Santolamazza, Caterina Altieri, Riccardo Magarini, Andrea Pietrabissa, Tommaso Dominioni, Luigi Pugliese, Andrea Peri, Marta Botti, Francesco Salvetti, Elisa Cassinotti, Ludovica Baldari, Luigi Boni, Valentina Messina, Vera D'Abrosca, Pasquale Cianci, Rocco Tumolo, Domenico Gattulli, Enrico Restini, Marina Minafra, Maria G Sederino, Bernardino Bottalico, Pierluigi Pilati, Boris Franzato, Genny Mattara, Ottavia De Simoni, Andrea Barina, Marco Tonello, Andrea Muratore, Marcello Calabrò, Nicoletta S Federico Pipitone, Bruno Cuzzola, Elena Herranz van Nood, Nicola Passuello, Alvise Frasson, Enzo Mammano, Luca Faccio, Fabrizio Vittadello, Alice Bressan, Giacomo Sarzo, Nicolò Tamini, Massimo Oldani, Luca Cigagna, Francesca Carissimi, Giulia De Carlo, Edoardo Baccalini, Luca Nespoli, Alessio Giordano, Stefano Cantafio, Lucrezia Grifoni, Davide Matani, Serena Livi, Daniele Delogu, Fabrizio Scognamillo, Antonio Marrosu, Luca Guerrini, Giampaolo Ugolini, Federico Ghignone, Giacomo Frascaroli, Nicola Albertini, Davide Zattoni, Giovanni Taffurelli, Isacco Montroni, Francesco Colombo, Piergiorgio Danelli, Andrea Bondurri, Anna Maffioli, Alessandro Bonomi, Isabella Pezzoli, Francesco Cammarata, Orlando Goletti, Mattia Molteni, Alberto Assisi, Giorgio Quartierini, Corrado Da Lio, Daunia Verdi, Isabella Mondi, Claudia Peluso, Lorenzo Macchi, Marta Tanzanu, Federico Zanzi, Sara Pellegrini, Jacopo Andreuccetti, Rossella D'Alessio, Giusto Pignata, Michele De Capua, Ilaria Canfora, Luca Ottaviani, Pasquale Lepiane, Andrea Balla, Antonio De Carlo, Federica Saraceno, Rosa Scaramuzzo, Anna Guida, Daniele Aguzzi, Paolo Bellora, Sergio Gentilli, Manuela Monni, Herald Nikaj, Nicola Cillara, Alessandro Cannavera, Antonello Deserra, Carla Margiani, Roberta Cabula, Manuela Dettori, Giulia Gramignano, Giovanni Lezoche, Monica Ortenzi, Elena S Orlandoni, Federica Curzi, Francesca Vitali, Perla Capomagi, Miriam Palmieri, Mario Giuffrida, Paolo Del Rio, Elena Bonati, Tommaso Loderer, Federico Cozzani, Matteo Rossini, Stefano Agnesi, Gabriella T Capolupo, Marco Caricato, Filippo Carannante, Gianluca Mascianà, Martina Marrelli, Valentina Miacci, Sara Lauricella, Valeria Tonini, Maurizio Cervellera, Salvatore Pisconti, Concetta Lozito, Juliana Shahu, Claudia Mongelli, Giulia Morelli, Lodovico Sartarelli, Giuseppe S Sica, Leandro Siragusa, Giulia Bagaglini, Bruno Sensi, Andrea M Guida, Marzia Franceschilli, Danilo Vinci, Antonio Taddei, Matteo Risaliti, Ilenia Bartolini, Maria N Ringressi, Luca Tirloni, Letizia Laface, Emmanuele Abate, Massimiliano Casati, Pietro Gobbi, Enrico Opocher, Nicolò M Mariani, Andrea Pisani Ceretti, Marco Giovenzana, Beatrice Giuliani, Martina Sironi, Ugo Grossi, Giacomo Zanus, Giulio Aniello Santoro, Marco Brizzolari, Eugenio De Leo, Simone Novello, Krizia Aquilino, Francesco Milardi, Stefano Olmi, Matteo Uccelli, Marta Bonaldi, Giovanni C Cesana, Marco Bindi, Raffaele Galleano, Antonio Langone, Massimiliano Botto, Angelo Franceschi, Elena Gambino, Maurizio Ronconi, Silvia Casiraghi, Giovanni Casole, Salvatore L Ciulla, Giovanni Terrosu, Sergio Calandra, Edoardo Scarpa, Vittorio Cherchi, Giacomo Calini, Lisa Martinuzzo, Lucrezia Clocchiatti, Davide Muschitiello, Andrea Romanzi, Barbara Vignati, Alberto Vannelli, Roberta Scolaro, Maria Milanesi, Fabrizio Rossi, Giuseppe Canonico, Alessandro Anastasi, Tommaso Nelli, Marco Barlettai, Riccardo Fratarcangeli, Carmela Di Martino, Andrea Damigella, Elvira Adinolfi, Arianna Birindelli, Lucio Taglietti, Sara E Dester, Francesco Fleres, Eugenio Cucinotta, Francesca Viscosi, Antonio Biondo Santino, Giorgio Badessi, Nivia Catarsini, Carmelo Mazzeo, Daniela Rega, Paolo Delrio, Carmela Cervone, Alessia Aversano, Silvia De Franciscis, Massimiliano Di Marzo, Bruno Marra, Ugo Pace, Antonio Amato, Paola Batistotti, Elisa Mina, Alberto Serventi, Pierfrancesco Lapolla, Andrea Mingoli, Paolo Sapienza, Gioia Brachini, Bruno Cirillo, Enrico Fiori, Daniele Crocetti, Ilaria Clementi, Gennaro Martines, Arcangelo Picciariello, Giovanni Tomasicchio, Rigers Dibra, Giuseppe Trigiante, Marcella Rinaldi, Giuliano Lantone, Alberto Porcu, Teresa Perra, Antonio M Scanu, Claudio F Feo, Alessandro Fancellu, Maria L Cossu, Giorgio C Ginesu, Alberto Patriti, Diego Coletta, Filippo Petrelli, Paola A Greco, Claudia Spadoni, Giovanna Cassiani, Federica Bianchini, Marco Arganini, Matteo Bianchini, Bruno Perotti, Matteo Palmeri, Stefano Scabini, Selene Deiana, Giacomo Carganico, Davide Pertile, Domenico Soriero, Emanuela Fioravanti, Beatrice Sperotto, Bruno Nardo, Daniele Paglione, Veronica Crocco, Marco Doni, Mariasara Osso, Roberto Perri, Gianluca M Sampietro, Carlo Corbellini, Leonardo Lorusso, Carlo A Manzo, Maria Cigognini, Caterina Baldi, Giuseppe Palomba, Giovanni Aprea, Marianna Capuano, Raffaele Basile, Roberta Tutino, Marco Massani, Laura Marinelli, Nicola Canitano, Tiziana Pilia, Mauro Podda, Adolfo Pisanu, Valentina Murzi, Silvia Incani, Federica Frongia, Giuseppe Esposito, Gaetano Luglio, Francesca P Tropeano, Gianluca Pagano, Eduardo Spina, Giuseppe De Simone, Michele Cricrì, Fausto Catena, Carlo Vallicelli, Nicola Zanini, Diana Ronconi, Francesco Favi, Carlo Mazzucchelli, Girolamo Convertini, Leonardo Vincenti, Valeria Andriola, Cinzia Bizzoca, Carlo V Feo, Nicolò Fabbri, Marta Fazzin, Antonio Pesce, Silvia Gennari, Marco Torchiaro, Silvia Severi, Alice Frontali, Greta Bracchetti, Stefano Granieri, Christian Cotsoglou, Massimo Carlini, Giorgio Lisi, Domenico Spoletini, Maria R Mastrangeli, Michela Campanelli, Michele Manigrasso, Marco Milone, Giovanni D De Palma, Sara Vertaldi, Alessia Chini, Francesco Maione, Alessandra Marello, Francesco Selvaggi, Guido Sciaudone, Lucio Selvaggi, Francesco Menegon Tasselli, Giacomo Fuschillo, Lidia Oddis, Simona Grande, Michele Grande, Simona Ascanelli, Laura Chimisso, Filippo Aisoni, Eleonora Rossin, Francesco Pepe, Francesco Marchetti, Biagio Picardi, Stefano Rossi, Simone Rossi Del Monte, Matteo Picarelli, Irnerio A Muttillo, Carlo Ratto, Angelo A Marra, Angelo Parello, Francesco Litta, Paola Campennì, Veronica De Simone, Francesco Pata, Cristiana Riboni, Emanuele Rausa, Valerio Celentano
Journal: JAMA Network Open (2022)

Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis.To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer.This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery.Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections.The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable.A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95% CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95% CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95% CI, 1.01-1.31; P = .03).This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients.